老年烧伤感染的防治研究进展

杨长发; 闵定宏; 郭光华

doi:10.3760/cma.j.cn501225-20220321-00078

老年烧伤感染的防治研究进展

doi: 10.3760/cma.j.cn501225-20220321-00078

南昌大学第一附属医院烧伤整形与创面修复医学中心，南昌　　330006

基金项目:

国家自然科学基金地区科学基金项目 82160376

江西省科学技术厅重点研发计划 20171ACG70004

详细信息

通讯作者:
郭光华，Email：guogh2000@hotmail.com

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- 文章访问数: 331
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- PDF下载量: 48
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-21
- 网络出版日期: 2023-03-23

Research advances on the prevention and treatment of burn infection in the elderly

Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China

Funds:

Regional Science Foundation Program of National Natural Science Foundation of China 82160376

Key Research and Development Plan of Science and Technology Department of Jiangxi Province of China 20171ACG70004

More Information

Corresponding author: Guo Guanghua, Email: guogh2000@hotmail.com

摘要

摘要: 感染是烧伤后的常见并发症，也是造成危重烧伤患者死亡的重要原因。老年人由于免疫功能下降、合并多种慢性疾病及各器官功能减退等原因，烧伤后感染更加严重。此外，老年烧伤感染缺乏特异性症状及体征，给其诊断与治疗带来巨大挑战。有效地预防和控制感染对老年烧伤患者救治而言极为重要。该文结合老年烧伤感染临床特点，从液体复苏、创面处理、抗生素使用、脏器保护、营养支持及感染预防等方面，总结老年烧伤感染防治研究进展，旨在为临床实践提供参考。
- 烧伤 /
- 感染 /
- 老年人 /
- 预防和治疗
Abstract: Infection is a common complication after burns and the major cause of death in patients suffering severe burn injury. The infection of the elderly after burns is more serious due to their decreased immune function that is complicated with factors such as multiple chronic diseases and dysfunction of various organs. In addition, the burn infection in the elderly lacks the specific symptoms and signs, which brings great challenges to its diagnosis and treatment. To effectively prevent and control infection is very important for the treatment of elderly burn patients. Combined the clinical characteristics of burn infection in the elderly, this paper summarized the research advances of prevention and treatment for burn infection in the elderly from fluid resuscitation, wound treatment, antibiotic using, organ protection, nutritional support, and infection prevention, aiming to provide reference for clinical practice.
- Burns /
- Infection /
- Aged /
- Prevention and treatment
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参考文献(40)

[1]	江政英,闵定宏,郭光华.老年烧伤治疗研究进展[J]. 中华烧伤杂志,2017,33(4):251-254. DOI: 10.3760/cma.j.issn.1009-2587.2017.04.016.
[2]	JeschkeMG, PhelanHA, WolfS, et al. State of the science burn research: burns in the elderly[J]. J Burn Care Res, 2020, 41(1): 65-83.DOI: 10.1093/jbcr/irz163.
[3]	WangWS,ZhangJH,LvYL,et al.Epidemiological investigation of elderly patients with severe burns at a major burn center in Southwest China[J].Med Sci Monit,2020,26:e918537.DOI: 10.12659/MSM.918537.
[4]	SavetamalA. Infection in elderly burn patients: what do we know?[J]. Surg Infect (Larchmt), 2021, 22(1): 65-68. DOI: 10.1089/sur.2020.322.
[5]	StanojcicM,ChenP,XiuFM,et al.Impaired immune response in elderly burn patients: new insights into the immune-senescence phenotype[J].Ann Surg,2016,264(1):195-202.DOI: 10.1097/SLA.0000000000001408.
[6]	中国老年医学学会烧创伤分会. 烧伤休克防治全国专家共识(2020版)[J]. 中华烧伤杂志,2020,36(9):786-792. DOI: 10.3760/cma.j.cn501120-20200623-00323.
[7]	KeckM,LumentaDB,AndelH,et al.Burn treatment in the elderly[J].Burns,2009,35(8):1071-1079.DOI: 10.1016/j.burns.2009.03.004.
[8]	GouldLJ, FultonAT. Wound healing in older adults[J]. R I Med J (2013), 2016, 99(2): 34-36.
[9]	PanJZ,PengML,LiaoC,et al.Relative efficacy and safety of early lactate clearance-guided therapy resuscitation in patients with sepsis: a meta-analysis[J].Medicine (Baltimore),2019,98(8):e14453.DOI: 10.1097/MD.0000000000014453.
[10]	BurnsB, JacksonK, FarinasA, et al. Eosinophil infiltration of burn wounds in young and older burn patients[J]. Burns, 2020, 46(5): 1136-1141. DOI: 10.1016/j.burns.2019.11.022.
[11]	MiddelkoopE,VloemansAFPM.Response to burns in the elderly: what is pathophysiology and what is physiology?[J].EBioMedicine,2015,2(10):1314-1315.DOI: 10.1016/j.ebiom.2015.09.009.
[12]	KhadimMF,RashidA,FogartyB,et al.Mortality estimates in the elderly burn patients: the Northern Ireland experience[J].Burns,2009,35(1):107-113.DOI: 10.1016/j.burns.2008.05.004.
[13]	罗志军,王和庚,陈杏绮,等. 早期削痂治疗老年深Ⅱ度烧伤创面早期加深的疗效[J]. 中国老年学杂志,2013,33(14):3300-3302. DOI: 10.3969/j.issn.1005-9202.2013.14.010.
[14]	WearnC,HardwickeJ,KitsiosA,et al.Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre[J].Burns,2015,41(6):1161-1168.DOI: 10.1016/j.burns.2015.04.008.
[15]	LachiewiczAM, HauckCG, WeberDJ, et al. Bacterial infections after burn injuries: impact of multidrug resistance[J]. Clin Infect Dis, 2017, 65(12): 2130-2136. DOI: 10.1093/cid/cix682.
[16]	PalackicA, PoppD, TapkingC, et al. Fungal infections in burn patients[J]. Surg Infect (Larchmt), 2021, 22(1): 83-87. DOI: 10.1089/sur.2020.299.
[17]	BradleySF.Principles of antimicrobial therapy in older adults[J].Clin Geriatr Med,2016,32(3):443-457.DOI: 10.1016/j.cger.2016.02.009.
[18]	HeilmannE, GregorianoC, AnnaneD, et al. Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials[J]. Age Ageing, 2021, 50(5): 1546-1556.DOI: 10.1093/ageing/afab078.
[19]	汤勇,王良喜,谢卫国,等. 多中心老年和中青年严重烧伤住院患者流行病学调查分析[J]. 中华烧伤杂志,2017,33(9):537-544. DOI: 10.3760/cma.j.issn.1009-2587.2017.09.003.
[20]	朱海涛,曹玉珏,屠海霞,等. 老年特重度烧伤并发室性心动过速一例[J]. 中华烧伤杂志,2018,34(8):564-565. DOI: 10.3760/cma.j.issn.1009-2587.2018.08.017.
[21]	中国老年医学学会烧创伤分会.吸入性损伤临床诊疗全国专家共识(2018版)[J].中华烧伤杂志,2018,34(11):770-775.DOI: 10.3760/cma.j.issn.1009-2587.2018.11.010.
[22]	FanE,BrodieD,SlutskyAS.Acute respiratory distress syndrome: advances in diagnosis and treatment[J].JAMA,2018,319(7):698-710.DOI: 10.1001/jama.2017.21907.
[23]	AllamNM, BadawyMM. Does high-frequency chest wall oscillation have an impact on improving pulmonary function in patients with smoke inhalation injury?[J]. J Burn Care Res, 2021, 42(2): 300-304. DOI: 10.1093/jbcr/iraa147.
[24]	吴亮,虞意华,李莉,等. 乙酰半胱氨酸雾化吸入联合支气管镜治疗老年重症呼吸机相关性肺炎的临床效果[J]. 中华烧伤杂志,2020,36(4):267-272. DOI: 10.3760/cma.j.cn501120-20200229-00107.
[25]	MomanRN, OstbySA, AkhoundiA, et al. Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study[J]. Ann Intensive Care, 2018, 8(1): 124. DOI: 10.1186/s13613-018-0468-5.
[26]	RosnerMH.Acute kidney injury in the elderly[J].Clin Geriatr Med,2013,29(3):565-578.DOI: 10.1016/j.cger.2013.05.001.
[27]	ClarkA, NeyraJA, MadniT, et al. Acute kidney injury after burn[J]. Burns, 2017, 43(5): 898-908. DOI: 10.1016/j.burns.2017.01.023.
[28]	Medina-LiabresKRP, KimS. Continuous renal replacement therapy in elderly with acute kidney injury[J]. Korean J Intern Med, 2020, 35(2): 284-294. DOI: 10.3904/kjim.2019.431.
[29]	GlasGJ,LeviM,SchultzMJ.Coagulopathy and its management in patients with severe burns[J].J Thromb Haemost,2016,14(5):865-874.DOI: 10.1111/jth.13283.
[30]	MolnárL, FülesdiB, NémethN, et al. Sepsis-associated encephalopathy: a review of literature[J]. Neurol India, 2018, 66(2): 352-361. DOI: 10.4103/0028-3886.227299.
[31]	姚咏明,张卉,童亚林. 深化对烧伤脓毒症诊断体系与治疗策略的认识[J]. 中华烧伤杂志,2021,37(5):404-409. DOI: 10.3760/cma.j.cn501120-20200703-00337.
[32]	WeiJY, ShiST, SunD, et al. Effect of the mini-nutritional assessment-short form in elderly burn patients[J]. J Burn Care Res, 2022, 43(1): 126-132. DOI: 10.1093/jbcr/irab164.
[33]	刘薇,艾宇航. 老年重症患者的营养支持策略[J/CD]. 中华老年病研究电子杂志,2019,6(1):17-20. DOI: 10.3877/cma.j.issn.2095-8757.2019.01.004.
[34]	邹日坤,费月海,韩晓博,等. 允许性低热卡营养在高龄慢性重症病人中的应用[J]. 实用老年医学,2020,34(2):149-151. DOI: 10.3969/j.issn.1003-9198.2020.02.012.
[35]	JinXY, WangJJ, MaYF, et al. Association between perioperative glycemic control strategy and mortality in patients with diabetes undergoing cardiac surgery: a systematic review and meta-analysis[J]. Front Endocrinol (Lausanne), 2020, 11: 513073. DOI: 10.3389/fendo.2020.513073.
[36]	PuH,DoigGS,HeighesPT,et al.Early enteral nutrition reduces mortality and improves other key outcomes in patients with major burn injury: a meta-analysis of randomized controlled trials[J].Crit Care Med,2018,46(12):2036-2042.DOI: 10.1097/CCM.0000000000003445.
[37]	ZhuYF, YinHY, ZhangR, et al. Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial[J]. Crit Care, 2018, 22(1): 170. DOI: 10.1186/s13054-018-2092-z.
[38]	陈华清,沈鸣雁,邵华伟,等. 基于美国医疗机构评审国际联合委员会标准的烧伤科医院内感染管理实践[J]. 中华烧伤杂志,2020,36(6):488-492. DOI: 10.3760/cma.j.cn501120-20190206-00020.
[39]	EllosoM, KambliA, AijazA, et al. Burns in the elderly: potential role of stem cells[J]. Int J Mol Sci, 2020, 21(13):4604. DOI: 10.3390/ijms21134604.
[40]	SalyerCE, BomholtC, BeckmannN, et al. Novel therapeutics for the treatment of burn infection[J]. Surg Infect (Larchmt), 2021, 22(1): 113-120. DOI: 10.1089/sur.2020.104.